Current hepatitis B virus infection situation in Indonesia and its genetic diversity

Abstract

Indonesia has a moderate to high endemicity of hepatitis B virus (HBV) infection. The risk for chronic HBV infection is highest among those infected during infancy. Since 1997, hepatitis B (HepB) vaccination of newborns has been fully integrated into the National Immunization Program. Although HBV infection has been reduced by the universal newborn HepB immunization program, it continues to occur in Indonesia. The low birth dose coverage and the presence of vaccine escape mutants might contribute to this endemicity among children. Although limited information is available for an analysis of occult HBV infection (OBI), several variations and substitutions in the pre-S/S region have been detected in Indonesian HBV strains. Additionally, persistent infection and disease progression of chronic hepatitis B are related to not only viral factors but also the host genome. Indonesia is one of the most ethnically heterogeneous nations, with Javanese and Sundanese as the two highest ethnic groups. This multi-ethnicity makes genomic research in Indonesia difficult. In this article, we focused on and reviewed the following aspects: the current hepatitis B immunization program and its efficacy, OBI, HBV infection among high-risk patients, such as hemodialysis patients, and research regarding the host genome in Indonesia.

Keywords: Hemodialysis; Hepatitis B virus; Immunization; Indonesia; Occult infection.

Figure 1

Prevalence of hepatitis B surface antigen in some provinces in Indonesia[11]. The provided number is the average number across all age groups, including the individuals born before and after the introduction of the immunization program. The population were those with more than 1 year of age (general population) in 2007, after 10 years of implementation of national hepatitis B immunization. For the provinces without the prevalence number, there are no available data (https://commons.wikimedia.org/wiki/File:Indonesia,_administrative_divisions_-_en_-_monochrome.sv).